{
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"OtherLastName": "PEREZ-MENDEZ",
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"FirstLineMailingAddress": "PO BOX 260211",
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"MailingAddressCityName": "PEMBROKE PINES",
"MailingAddressStateName": "FL",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "9370 SW 72ND ST STE A150B",
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"PracticeLocationAddressCityName": "MIAMI",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "305-455-7437",
"PracticeLocationAddressFaxNumber": "305-455-7435",
"EnumerationDate": "01/05/2010",
"LastUpdateDate": "10/01/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": "ME136195",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}